A concussion is typically induced by trauma to the brain, often caused by a direct blow to the head or even an indirect blow to the body. A concussion is characterized as some sort of impairment to the brain in which symptoms resolve spontaneously. These symptoms usually reflect a functional disturbance to the brain and may include physical (e.g., headaches, nausea), cognitive (e.g., difficulty with concentration or memory), emotional (e.g., irritability, sadness), and “maintenance” (e.g., sleep disturbances, changes in appetite or energy levels) symptoms. A concussion is considered a brain injury.

How does a concussion affect a student?

Even though a concussion may occur outside of the classroom, its effects often become visible when a student is exerting him or herself cognitively. In other words, the symptoms associated with concussions will not only surface when the person is physically active, but also when they are mentally active. Common classroom activities can exacerbate the symptoms of a concussion and slow the recovery time, and experts may suggest some type of accommodations to help avoid these problems.

Common concussion systems and academic accommodations

Concussion Symptoms

Academic Performance Deficits

Academic Accommodations (Suggested)

Physical

Headache

Fatigue

Sensitivity to Light/Noise

Visual Problems

Inability to Retain/Recall Information

Attention Deficits

Difficulties Following Instruction

Allow Frequent Breaks

Removal from P.E. and

Music Classes

Discourage Heavy Backpacks

Cognitive

Mental Fogginess

Concentration Troubles

Memory Troubles

Feeling “Slowed Down”

Inability to Learn, Plan, and Organize (e.g., time management, etc)

Recall Deficits

Troubles with Time Sensitive Assignments

Reduce the Amount of Homework

Pre-Printed Class Notes

Allow for Untimed Testing

Emotional

Irritability

Sadness

Nervous/Anxious

More Emotional than Usual

Highly Sensitive

(e.g. socially, internally)

Decreased Attention Ability

Lack of Motivation

Support and Encouragement

Provide Options for Individual Work

Provide Place for Quiet Rest

Maintenance

Drowsy

Lethargic

Trouble Falling Asleep

Sleeping More than Usual

Inability to Process Information

Potential for Depressive and/or Anxious Behaviors

Reduced/Modified School Day/Week

Brief Homework Assignments

How is a concussed youth different from a concussed adult?

There is a distinct difference between kids and adults when it comes to treating and managing concussions. Developmentally, it is vital to conservatively manage a concussed child due to the nature of the exponential growth of the young brain. Studies have shown that children with more concussions are not only more likely to sustain additional concussions, but they are also more likely to suffer long-term neurological deficits than children who do not sustain multiple concussions. Adults, on the other hand, are neurologically more developed, which results in fewer symptoms and quicker recovery times after mild head injuries. Due to this heightened risk among youth, a multi-disciplinary approach to concussion management is recommended by the Sports Concussion Institute and other concussion experts, and the active social support from teachers, coaches, parents, teammates, and other medical professionals is essential to the youth’s recovery.

What is the role of the academic professional in concussion management?

Education: It is essential to include the academic professional in the complete care and management of concussion. The main “job” of a young student-athlete is to progress in the academic environment, and a concussed brain will certainly effect their ability to perform cognitive tasks. With a preponderance of research and clinical focus on the student-athlete’s Return to Play (RTP), there is a recent push among experts to also focus on the safe Return to School (RTS) of the student-athlete. As outlined in the REAP: The Benefits of Good Concussion Management (McAvoy, 2009), the general rule of thumb is to Reduce cognitive activity, Educate yourself and others about the debilitative effects of concussions, Accommodate to assist the child during the period of recovery, and gradually Pace their full return to physical and cognitive activities.

Monitor Symptoms: In addition to education, academic professionals should also monitor the student for any concussion symptoms during the recovery stage. In most cases, symptoms tend to resolve gradually and spontaneously in the following days or weeks after the concussion. When parents, teachers, coaches, and others involved with the management of the injury are actively monitoring symptoms, it creates a supportive, caring environment that can positively influence the recovery process. A list of concussion symptoms can be found in REAP Program Manual or the HeadSmart Handbook.

Case Study

BN was half-way through his senior year in high school when he was concussed during a baseball game. His immediate symptoms included dizziness, headache, sensitivity to light, and emotional disturbances. Once the game ended, BN could not sleep very well due to the lingering symptoms. The next day in class, he had trouble concentrating on academic tasks, which led to a decrease in performance on homework assignments, tests, and class participation. BN describes the experience of being fearful for his athletic and academic future:

“It was like my brain was out of whack, or something. I couldn’t concentrate on anything, and I had to rub my eyes and my temples throughout class just to keep it together. My grades starting to drop a bit because I would forget to do homework, or forget how to do something right (correctly), and had pretty bad test scores for like a week or two. At the same time, I was trying to get into colleges. I started to get really scared that I wouldn’t get into my top choices, and even if I did, I wouldn’t be able to play (baseball).”

BN decided that trying to “tough out” the symptoms wouldn’t help him any longer, and he went to his coach to tell him about his problems in school since the game:

“So, I went to my coach, and luckily, he knew my teacher. So, he went to my teachers and told them ‘Hey, my guy got a concussion last week in a game’ and basically worked with them to help me in class. I had a chance to sit down with my coach, my teachers, the school athletic trainers, and even my parents and talk about what I was feeling. It was cool to see how much everyone cared for me. I really needed that.”

At a time when BN needed a break from sports and school, he was provided appropriate accommodations. This temporary “help” included a chance to skip athletic practices until he started to feel symptom-free, and in the classroom BN received pre-printed class notes and reduced homework assignments.

“After a couple of weeks, I began to feel better. It was good because then I could slowly get back to playing sports, hanging out with friends, and doing well in school again.”

As a student-athlete, BN’s concussion symptoms would surface throughout the day, regardless of what tasks he was doing. BN describes being lucky to have coaches, teachers, and parents collaborate on his behalf. Not only did this approach help to manage BN’s cognitive and physical symptoms in school and sports, but having the multiple adults in his life work together for his overall health may have prevented the emotional distresses associated with preparing for the transition to college. BN was able to attend the college of his choice play baseball without further injury.